Medical examining method and means

ABSTRACT

A device for viewing the cervix and vaginal segment of a human uterus has two, three or four elongate blades removably mounted on a holder. The blades are adjustable to spread and to retain the vaginal walls including the cervico-vaginal fornix for visual observation and accessibility of surgical instruments to the uterus. A handle supports the blades and preferably has illumination sources and, optionally, a viewing lens mounted thereon. Each of the blades includes means at its distal end for securely engaging the exterior peripheral rim of a cervix for immobilizing it during surgical procedures. The two blades are resiliently biased towards each other.

United States Patent 1 1 McDonald ['11] 3,744,481 [451 July 10,1973

[ MEDICAL EXAMINING METHOD AND 21 Appl. No.: 144,468

[52] U.S. Cl. 128/006, 128/002 B, 128/017 [51] Int. Cl A6lb 1/06, A61b 1/30,A61b 1/32 [58] Field of Search [28/6, 17, 18,2 B

[56] References Cited UNITED STATES PATENTS 447,761 3/1891 Clough 128/017 475,975 5/1892 Clough.... 128/017 810,675 l/l906 Richter... 128/017 1,139,015 5/1915 Cerbo 128/018 X 2,082,782 6/1937 Allen 128/017 2,858,826 11/1958 Kahn 128/017 3,320,948 5/1967 Martin 128/017 3,413,067 11/1968 Froio 128/006 3,532,088 10/1970 Fiore 128/018 Primary Examiner-Channing L. Pace Attorney-Edward H. Loveman [5 7 ABSTRACT A device for viewing the cervix and vaginal segment of a human uterus has two, three or'four elongate blades removably mounted on a holder. The blades are adjustable to spread and to retain the vaginal walls including the cervico-vaginal fornix for visual observation and accessibility of surgical instruments to the uterus. A handle supports the blades and preferably has illumination sources and, optionally, a viewing lens mounted thereon. Each of the blades includes means at its distal end for securely engaging the exterior peripheral rim of a cervix for immobilizing it during surgical procedures. The two blades are resiliently biased towards each other.

16 Claims, 30 Drawing Figures PAIENIEB 1 ("973 SHEEI 3 0f 7 INVENTOR- I aaeumo MDouALo KM AMT PArzmmm 3.744.481

snmsur'! INVENTOR.

BERNARD MCDONALD ATWEY Pmmmm I 01918 sumw'l Afrozuar BACKGROUND OF THE INVENTION In a normal dormant state, the walls of the vagina are situated in close juxtaposition about their axial center, thus preventing direct visual observation of the cervix uteri as required for medical examination or surgery thereon. The prior art includes a familiar type of device known as a vaginal speculum having two elongate metal blades pivotally joined together about a fulcrum, whereby parting of the blades after their initial placement in situ separates and holds apart the vaginal walls unidirectionally. The foregoing type of device applies localized pressure on two oppositely confronting vaginal wall portions to establish and maintain a small distance between the same, but does not otherwise engage the walls in a manner which would prevent their displacement during contact by surgical instruments or the like. It is an inherent disadvantage of vaginal specula that the fulcrum supporting structure, and of the holding means for retaining the blades in a spacedapart relationship, unavoidably restrict both the access area and the field of view of the situs which is sought to be examined or operated upon, particularly when instrumental contact with the cervix must be made.

In order to surgically or diagnostically operate on the cervix, as associated with conization, cauterization, specimen collection of the like, it is necessary to hold the organ securely againstmovement. The device most widely used in the prior art for this purpose is of the type known as tenacula. A tenaculum forcibly engages and holds the cervix to prevent its movement during surgical procedures involving the cervix uteri. This type of instrument is functionally distinguishable from the vaginal specula in that the latter does not grasp anything but merely spreads the vaginal wall unidirectionally apart, and it is not an uncommon practice for some operative techniques to involve both instruments simultaneously, which is especially cumbersome, confining, and severely restricts both the field of observation and the freedom of surgical instrument movement. Moreover, neither of the types of instrument discussed above offers any solution to the problem of providing adequate illumination to permit detailed examination of surfaces within the uterus.

SUMMARY OF INVENTION The invention consists of a manually portable medical instrument, one embodiment as seen in FIGS. 1-5 consisting of device 10, generally comprising a handle 12, a hollow housing 14 mounted thereon, and a plurality'of blades 16, 18, and 20 releasably secured to the housing. Illumination means 56 and 58 are mounted on housing 14 and are electrically energized by dry cell batteries within handle 12. Twoor more blades such as BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 shows a general perspective view of the inventive device in sample illustrative form,

FIG. 2 shows an end elevational view, partly fragmented, of a portion of the device from FIG. I,

FIG. 3 shows a side elevational view, partly fragmented, of the structure shown in FIG. 2,

FIG. 4 shows a top plan view of the structure seen in FIGS. 2 and 3,

FIG. 5 shows a cross-sectional view taken along line 5-5 in FIG. 4,.

FIG. 6 is an isolated view, partly in cross-section, of a detail from the structure seen in FIGS. 2, 3 and 4,

FIGS. 7 and 8 are isolated views of two modifications involving details of the structure seen in FIGS. 1

I through 5, FIGS. 9 and 10 are both fragmented perspective views of two modifications involving details from structure shown in FIG. 1,

FIG. 11 is an isolated fragmentary plan view, partly in cross-section showing a detail from the structure in FIG. 4, I

FIGS. 12, 13 and 14 are isolated fragmentary perspective views showing modifications of a detail from the structure seen in FIG. 1,

FIG. 15 is an isolated, fragmented view of a detail of structure suggested by broken lines in FIG. 2, FIG. 16 is an end elevational view, partly fragmented, of a mod ification of the device shown in FIGS. 1 through 5,

FIG. 17 is a side elevational view, partly fragmented, of the structure shown in FIG. 16,

FIG. 18 is an isolated perspective view of two component detailed parts from the structure shown in FIGS. 16 and 17,

FIG. 19 is an end elevational view, partly fragmented, of another modification of .the device differing from that shown in FIGS. l-5 inclusive, and in FIGS. 16 through 18, inclusive,

FIG. 20 is a side elevational view, partly fragmented, of the structure shown in FIG. 19,

FIG. 21 is an isolated perspective view of two component detailed parts from the structure shown in FIGS. 19 and 20,

FIG. 22 is an end elevational view, partly fragmented, of a fourth modification of the device differing from those shown in FIGS. l-S, inclusive; in FIGS. 16 through 18, inclusive; and in FIGS. 19 through 21, inclusive,

FIG. 23 is a side elevational view, partly in crosssection and fragmented of the structure shown in FIG. 22,

FIGS. 24, 25 and 26 are isolated perspective views of three component detailed parts, respectively, from the structure shown in FIGS. 22 and 23,

FIG. 27 is general perspective view of a fifth modification of a device incorporating the inventive principles taught herein and differing from all the other modifications shown in the previous Figures,

FIG. 28 is a side elevational view of the structure shown in FIG. 27,

FIG. 29 is a front elevational view of the structure shown in FIGS. 27 and 28, and

FIG. 30 is an isolated fragmentary view, partly in cross-section, of a portion of the structure shown in FIGS. 27 through 29, inclusive.

DESCRIPTION OF THE PREFERRED EMBODIMENT Referring to the first embodiment shown in FIG. 1, it may be seen that the novel structure is a manual implement generally designated by reference numeral 10 having handle portion 12, housing assembly portion 14 and elongate blade elements 16, 18 and '20 secured thereto. Housing portion 14 principally comprises mounting block 22, hollow box member 24 best seen in FIG. 5, and oppositely confronting brackets 26 and 28 secured in pivotal relationship with block 22 by suitable pivots and holding means as suggested by pivot screw 30.

As further seen in FIG. 5, handle 12 may be shaped and sized to accommodate one or more standard dry cell batteries such as battery 32 axially aligned within the handle. Block 22 is provided with a flanged cylindrical cavity adapted to fit over the adjoining upper end of handle 12 and to be secured thereto by suitable means such as a lug 46 projecting from handle 12 as seen in FIG. 2 and engaging an offset or eccentric groove 33 formed in circular flange 34. Hollow box member 24 may be of sheet metal construction and has a flat upper surface 36 joined to four downwardlydepending sides including laterally spaced-apart side portions 38 and 40 seen in FIG. 5, as well as forward and aft portions 42 and 44 situated in the manner suggested by FIG. 4.

Brackets 26 and 28 are adjustably pivotal with respect to block 22 and held in any desired position of adjustment by knurled knobs 48 and 50, respectively, seen in FIG. 5, for example. Both mentioned brackets include support means for blade elements 16 and 18 in the form of spaced-apart apertures such as suggested by apertures 52 and 54 in brackets 26 and 28, respectively, seen in FIG. 2. The blade elements, which are preferably of rigid or stiffly deformable material, are releasably secured within the mentioned apertures such as by deforming the blades into slight arcuate crosssectional shape, inserting the same through the apertures, and then releasing the same. Residual stress in the deformed blade material will tend to flatten the blades against the restraint offered by the surrounding aperture edges in the manner suggested particularly by blade 16 in aperture 52 of bracket 26 shown in FIG. 6. With appropriate sizing of interfitting components no further retention means need be utilized to secure blade 16 in bracket 26. However, where greater security against movement of the mentioned blades relative to their supporting brackets is desired, depending upon the materials selected, a head or projecting ridge of substantially greater width than slots 52 or 54 may be formed on the blades as suggested by intermediate ridge 86 on blade 18 contacting the forward edge of bracket 28 in FIG. 7, or by terminal ridge or bulbous projection 90 contacting the aft edge of bracket 28 as seen in FIG. 8. Projection 90 is adapted to be manually broken off by application of force sufficient to fracture through blade 18 at reduced cross-section groove 91 to facilitate removal of blade 18 from bracket 28 after use of the device. In either case, it will be understood that only one of the expedients suggested by FIGS. 7 and 8 is used on any one'blade 18 and not both on the same blade.

Illumination means are also included in implement l and preferably include at least two light sources .such as bulbs 56 and 58 situated within light-containing covers 60 and 62, respectively. Bulbs 56 and 58 are connected electrically by suitable means to the batteries within handle 12 such as suggested by leads 64 and 66 in FIGS. 4 and 5, and are energizable by an appropriate switch 68 shown in FIG. 2, for example. Covers 60 and 62 preferable have limited illumination escape means such as narrow slits to permit the controlled escape of light as suggested by slit 70 in cover 60 over bulb 56 shown in FIG. 11. Due to the foregoing relationship, light rays emitted through slit 70 will enter the material in blade 16 which is preferably adapted to receive the same and conduct such light rays to the distal end of the blade opposite from its supporting portion within aperture 52. The light rays so conducted according to the principles of fiber optics willthereafter be emitted from the stated distal blade end and illuminate the surfaces within the body cavity in which blade 16 is situated. To facilitate or enhance the light-receiving and transmitting properties of blade 16, a portion of the surface thereof is preferably cut away as shown by surface 72 in FIG. 11 to produce a planar surface portion 74 oriented substantially normal to the dominant direction of the light rays emitted from source 56 through slit 70.

As further suggested by the modifications shown in FIGS. 9 and 10, blade 16 may be strengthened by integrally formed beads at the center thereof in the manner shown by bead 76 on blade 17 of FIG. 9, or by beads 78 and 80 at the edges of the blade as shown by blade 7 19 in FIG. 10. The mentioned strengthening means are usable to increase resistance-to bending of the blades along their length, but the blades may also be provided with a groove or other means defining a linear area of localized weakness oriented transversely across each blade to facilitate fracture thereof as required to break off the blades to dispose of the same when their material of construction is conductive to such disposability.

Lower blade 20 is provided near the distal end thereof with holding means for engaging and holding a radially contracted peripheral rim such as characterized by the cervix, by radially inward directed pulling force applied either directly to the cervix or closely proximate thereto, in order to grasp the same and to secure the cervix against movement or displacement upon contact with other surgical implements. In the example shown by FIG. 12, the stated means comprises integrally formed and spaced-apart projections 82 which may be of generally conical form situated with the major axis at a slanted angle relative to the principal center or longitudinal axis of blade 20, the stated angle being preferably about 75 degrees from the mentioned axis as suggested by angle A in FIG. 12, although this angle could vary from 45 to degrees. The distal edges or tips 84 on projections 82 are adapted to engage the lower outside rim of the cervico-vaginal fornix and apply pulling force thereto radially outwardly to stabilize the same against movement or to dilate the same. Alternatively, projections 82, which are preferably formed with spanwise breadth in the shape of a tooth, may be omitted and replaced by small vacuum or suction cups as suggested by cups 88 in FIG. 13. Cups 88 are of flexible resilient material and have a thin easily deformed peripheral edge thereon capable of adhering to a moistened surface when pressed firmly thereagainst. A further modification is suggested by FIG. 14 wherein cups 88 communicate with one or more hollow passages such as passage, 89 in blade 20 which may be connected to an external vacuum source (not shown).

From the foregoing, it may be seen that the construction of device 10 adapts the same particularly for use in clinical or surgical manipulations associated with the structure of the human cervix. Thus, since the cervix is deeply recessed within the vaginal passage, it cannot be operated upon unless the vaginal walls are sufficiently displaced to permit access to the situs of the cervix and otherwise stabilized to minimize or prevent their movement. In order to gain such access initially, blades 16, 18 and 20 should be contractible or displacable generally toward each other to achieve, inso far as possible, mutual contact between the blades along most of their length. This contraction of the blades into a close grouping relationship allows the blades to be inserted into the vagina with a minimum of difficulty or discomfiture to the patient. Thereafter, blades 16 and 18 are displaced apart from each other by rotation of their supporting brackets 26 and 28, respectively, about a rotation axis through pivot screw 30, until the blades are spaced-apart in the position shown by FIG. 1. This will result in lateral displacement of the vaginal wall whereby the cervix may be viewed. When thus viewed, blade 20 is then moved by manipulation of the entire implement as required to engage projections 82 against the cervix by contacting the same along an area on the far side of the tough callous ridge which surrounds the outer periphery of the normal human cer- Use of device 10 in the manner described above may be seen to provide the simultaneous advantages of holding separated the vaginal walls to provide access to the cervix and securely engaging a peripheral portion of thecervix to hold the same against displacement, both in a single device which may be easily positioned at any desired angularity according to the convenience of the surgeon or diagnostician using the same.

After positioning of the device, detailed observation and further operative procedures may be accomplished using viewing means such as suggested in FIGS. 2, 3 and 15. From FIGS. 2, 3, and 15, it may be seen that brackets 26 and 28 are preferably provided with upstanding lugs or bosses 100 each having a tapped hole therethrough. The holes thus formed in brackets 26 and 28 are each adapted to receive the threaded shank ofa thumbscrew 97 and 98, respectively. A yoke member 92 has a laterally extending support beam 94 with a slot at each end thereof as suggested by slots 95 and 96 in FIG. 15. The yoke 92 is thus supported on brackets 26 and 28 by thumbscrews 97 and 98 in such manner that tightening of the thumbscrews clamps the yoke firmly against the brackets. Conversely, when the thumbscrews are loosened the brackets may be pivoted toward or away from each other about a center axis through holding screw 30, and yoke 92 will always be 1 adjustable so that slots 95 and 96 are equidistantly spaced from holding screw 30. Yoke 92 is also formed with a magnifying eyepiece 93 of any suitable commercially available type whereby the viewing means thus formed perm-its a direct line of vision between blades 16 and 18 after they have been positioned in the spaced-apart relationship shown by FIGS. 1 and 2, for example.

While a number of modifications are suggested herein as discussed below, it is basic in all of these modifications which incorporate the inventive principles taught herein that a single device is adapted to perform both of the functions formerly identified with the separate types of medical instruments broadly characterized as specula and a tenacula, and also provides additionaladvantages not associated with either such types.

Spreading or distention of the vaginal walls and grasping or otherwise securely engaging the outer peripheral surface of the cervix involves two very different functional operations. The first is achieved in all modifications of the device disclosed herein by initially placing at least two elongate blade elements within the vaginal passage, and displacing the blade elements away from each other a sufficient distance to permit visual access entirely through the vaginal passage to view the cervix. The second function is performed after the mentioned access is gained and consists of engaging the rim of the cervix about its outer periphery by structure adapted to apply sufficient force to stabilize the cervix against displacement by physical contact with other surgical, clinical, or diagnostic implements.

In some cases, depending upon the size or location of the rest or surgical situs and upon configurational differences between the vaginal contours of different patients, it may be necessary to vary the type of extent of blade movement or position best suited to the needs of the doctor. Accordingly, the embodiment suggested in FIG. 16, for example, permits use of four. blades rather than three as shown in FIG. 1, and further permits a wider variation in angular and translational adjustability of theblades than that permitted by the structure of FIG. 1.

Thus, hollow handle 102 in FIG. 16 corresponds in function with handle 12 in FIG. 5, except that handle 102 has U-shaped bracket 104 affixed thereto by any suitable means such as by integral construction, or by a bayonet-type connection 33, 46 as described between block 22 and handle 12 seen in FIGS. 2 and 5, for example. Bracket 104 has transverse center portion 106 formed with upstanding brackets or bosses 108 and 110 at either end thereof. Sized to extend between bosses 108 and 110 is a solid mounting block 1 12 held in place by two thumbscrews 114 and 116 in axial rotational alignment and penetrating through suitable holes in bosses 108 and 110, respectively. Loosening of screws 1 l4 and 116, each of which has a threaded shaft engaging a threaded hole in block 1 12, permits pivotal movement of the block relative to bracket 104 about an axis through the center of screws 114 and 116.

Block 112 has a pair of tapped holes adapted to receive the threaded shafts of two more thumbscrews 1 18 and shown in FIG. 17, the center axes of which are in mutual alignment and oriented perpendicular to the center axes of thumbscrews 114 and 116. The mentioned threaded shafts of screws 118 and 120 penetrate through two smooth holes in a pair of downwardly depending lobes or bosses 122 and 124, respectively, formed on housing box 126 and illustratively by lobe 122 in FIG. 18. Lobes 122 and 124 permit box portion 126 to be adjustably pivoted about an axis through the center of screws 118 and 120 when the screws are loose, and to be immovably joined to block 112 when the screws are firmly tightened so as to clamp the lobes against the block.

Box portion 126 has transverse base portion 128 and upstanding side portions 130 and 132 as seen,- for example, from FIG. 18, together with forward and aft portions 134 and 136, respectively. Forward-and aft portions 134 and 136 are provided with aligned slots 138 and 140 adapted to receive a blade such as blade 20 in the same manner and purpose as shown and discussed above in connection with FIG. 1. Box portion 126 is adapted to receive and support another box portion 142 in nesting relationship. Box portion 142 may be seen to include a pair of downwardly depending side portions 144 and 146 integrally formed or otherwise secured to a pair of transverse frame portions 148 and 150 comprising forward and aft surfaces of box portion 142, respectively. Frame portions 148 and 150 include slots 152 and 154, respectively, to receive and support an elongate blade-like element corresponding in form to blade shown in FIG. 1 but oriented oppositely in respect thereto.

Box portion 142 is vertically slidable relative to and supported within box portion 126, the side portions 130 and 132 of box portion 126 being in substantially uniform surface contact with side portions 144 and 146, respectively, of box .portion 142. The limits of such relative movement are defined by the length of slots 156 and 158, through which separate thumbscrews 160 and 162 threadedly secured in side surfaces 144 and 146, respectively, penetrate as suggested by holes 164 and 166 is side portions 144 and 146 as shown in FIG. 18 and adapted to receive thumbscrews 160 and 162 shown in FIG. 16. It will be understood that tightening of the thumbscrews by rotation thereof will cause them to clamp against the sides of slots 156 and 158, thus preventing movement between box portions 126 and 142, and holding the same in any desired position of adjustment, and that this position of adjustment will determine the adjusted distance between the two elongate blades 180 and 182 which are respectively secured within slots 138, 140 of box portion 126, and within slots 152, 154 of box portion 142. A separate pair of aligned slots on each side of box portion 142 is adapted to receive two more elongate blades 170 and 172 as suggested by slots 174, 176 and 178 seen in FIG. 18, for example. To complete the instrument shown in FIG. 16, 'for example, viewing means in the form of eyepiece assembly 184 is desirably included and corresponds in structure and mounting arrangement generally as described above for viewing means 92 shown in FIG. 15, except for certain obvious variations necessitated by the different overall configuration of the implement.

From the discussion set forth above, it will be understood that pivotal adjustment about two axes may be made in the device shown by FIGS. 16 and 17, these axes being defined by the common rotation axis of thumbscrews 114 and 116 in the first instance, and of thumbscrews 118 and 120 in the second instance. Moreover, after initial placement of the instrument in the examination or operative situs, lateral blades 170 and 172 will retain the vaginal walls distended or spaced-apart, while blades 180 and 182 may be positioned so that grasping means on the distal end of each blade corresponding to those discussed for blade 20 may grasp or otherwise secure the cervix against displacement.

Referring to FIGS. 19 through 21, another embodiment of the basic inventive principles may be seen wherein four blades are involved, similar to the embodiment of FIGS. 16 through 18. However, instead of the lateral blades being mounted in fixed relationship regarding the distance therebetween, and the vertically spaced-apart blades being adjustable as to the space therebetween as in the device shown by FIGS. 16 through 18, the device in FIGS. 19 through 21 involves vertically spaced blades 226 and 228 which are not adjustable as to spacing, and laterally spaced blades 230 and 232 which are adjustably variable as to the distance therebetween.

Referring to FIG. 19, hollow handle corresponds in function with handle 102 in FIG. 16 and has U- shaped bracket 192 secured thereto by any appropriate means such the bayonet connection 33, 46 shown in FIG. 2. Bracket 192 supports block 194 between two releasable clamping thumbscrews 196 and 198 in the same manner as block 112 described above in connection with FIG. 16. Block 194 in turn pivotally supports a generally box-shaped assembly 200, 202 in the same manner as discussed above regarding block 112 and its relationship with the box assembly formed by elements 126 and 142. Thus, a pair of thumbscrews 204 and 206 in mutual alignment have threaded shafts which engage tapped holes in block 194 and served to clamp two lobes 208 and 210 formed on box element 200 to prevent its movement relative to block 194 when the thumbscrews 204 and 206 are firmly rotated into clamping position.

Box elements 200 and 202 nest together in translationally slidable relationship in the manner discussed above for box elements 126 and 142, except that the latter are vertically movable where the elements 200 and 202 are laterally movable. Spaced-apart and aligned pairs of slots formed in each of the elements 200 and 202 are adapted to receive blade elements of the same type as discussed above in connection with blades 16, 18 and 20 in FIGS. 1-5. The mentioned slots include slots 212, 214, 216, 218 and 220 in element 200 and slots 222, 224 in element 202, all of which support blades 226, 228, 230 and 232 shown or suggested in FIGS. 19 and 20. Relative movement between box elements 200 and 202 result in adjustably varying of distance between blades 230 and 232, after which tightening of thumbscrew 234 holds the mentioned elements in the, desired position and prevents further movement thereof.

In the device shown by FIGS. 19 through 21, blade elements 230 and 232 could appropriately be provided with positive grasping means to secure the cervix such as shown in FIGS. 12, 13 or 14 and discussed above. Use of the device which permits lateral adjustment of blade distance between blades 230 and 232 would be appropriate in those cases where the localized area of medical and pathological interest in the patient would be obscured, irritated or otherwise poorly suited to the vertical type blade adjustment provided by the device of FIGS. 16-18. As in the case-of the latter instrument, it will be understood that suitable optical or magnifying means may be supported substantially at the center of the box assembly 200, 202 shown in FIG. 19 as discussed above for viewing means 184 in FIG. 16. Similarly, illuminating means involving use of fiber optic material for any or all of the blades 226,228, 230 or 232 could be used in connection with the device discussed above in connection with FIGS. 16-18 or 19 through 21. Alternatively, any of the modifications disclosed herein could be used in combination with a miniature flashlight to provide a direct beam of light toward the test situs instead of using fiber optics.

Although both of the embodiments suggested in FIGS. 16-18 and in FIGS. 19-21 provide results and advantages unobtainable with devices known to the prior art, both have the basic functional limitation that at least one pair of blades required to be inserted within the vaginal passage are non-adjustable as to the distance therebetween. It is a distinct advantage, both from the medical practitioners, as well as from the patients, viewpoint, if all the blades can be so collapsed or closely grouped that penetration into the vaginal passage is relatively easy after which the blades may be.

precise localized area of interest to the surgeon or diagnostician, it would be most helpful in either case for rotary adjustment .to be accomplished without the need for external weights or angular displacement of the en tire implement to achieve desired relative positioning between the various blades used for spreading apart the vaginal walls and for grasping the cervix. It would, in other words, be desirable and advantageous for the instrument used both to gain access to the inner vaginal terminal area and to engage the cervix, to accomplish these functions by completely adjustable blades offering a minim of resistance to penetration into the vaginal constriction which typifies the normal patient and permits angular positioning of the blades. Although complete adjustability in the foregoing sense is not achievable in the embodiment discussed hereinabove, this objective is achieved to a most remarkable extent in the devices suggested by the modifications of FIGS. 22-30, inclusive.

. Referring to FIG. 22, a modification is shown wherein handle 240 is secured to two semi-circular elements 242 and 244 shown in FIGS. 24 and 25, respectively, each having a portion of an arcuate track or guide as suggested by tracks 246 and 248 on element 242 and by tracks 250 and 252 on element 244. When these two elements 242 and 244 are secured to handle 240 in operative relationship by suitable means such as threaded screw 254, two separate parallel and perfectly circular tracks are formed, one comprising portions 246 and 250, while the other track comprises portions 248 and 252.

Within the stated tracks a supporting frameor chassis 256 is slidably movable throughout 360 degrees of rotation relative to the stationary elements 242 and 244, as required to position the same in any desired condition of adjustment prior to use of the instrument. Chassis 256 is so constructed as to constitute a single unitary element including two circular support rings 258 and 260 which are each substantially planar and uniformly parallel to each other. The rings 258 and 260 are joined in fixed relationship by a connecting mass in the form of block 262. Block 262 functions essentially similar to block 22 discussed above in connection with FIG. 5. Thus, hollow box 264 in FIG. 23 corresponds with box member 24, while brackets 266 and 268, pivotally secured to block 262 by adjustable holding screw 270 corresponds to brackets 26, 28 and holding screw 30 shown in FIG. 2. Suitable slots 272, 274 and 276 in elements 264, 266 and 268, respectively, are adapted to receive and support elongate blade elements in the same manner as blades l6, l8 and of FIG. 1, as suggested by blades 278 and 280 in FIG. 23.

From the above, it will be understood that complete 360 degree freedom is permitted in the initial adjustment of the blade elements using the device of FIGS. 22-26, and that adjustment is accomplished by rotating block or mass 262 along a path defined by the circular tracks within which rings 258 and 260 are confined and guided. When a desired positional adjustment is achieved, a holding screw 282 having a threaded shaft operatively engaging a tapped hole 284 in block 262 (see FIG. 26) is turned to apply clamping force to ring elements 246 or 250 and thus prevent further rotational movement. As further discussed above, optical viewing means of the type suggested in FIG. 15 may be included in the device shown by FIGS. 22 and 23.

A further modification of the device disclosed herein is shown by FIG. 27 wherein two handle elements 300 and 302 are pivotally joined together about a pivot axis defined by pin 304 having shaft 306 which penetrates through lobe portion 308 formed on handle element 300 as seen in FIG. 29.

Handle element 302 includes an upwardly extending lobe 310 having a slot 312 therein. A thumbscrew 314 has a threaded shaft 316 operatively engaging a tapped hole 318 in a blade support element or bracket 320 seen in FIG. 29. Shaft 316 is linealy movable within narrow slot 312 to displace bracket 320 toward or away from the pivot axis defined by pin 304. Blade support means are included in bracket 320 as well as in another bracket 322formed integrally with or otherwise secured to handle element 300. The stated means comprise slots or cavities 324 and 326 in brackets 320 and 322, respectively, in each of which is releasably secured a blade corresponding to blade 20 shown in FIGS. 1 and 12. Because pivot pin 304 is positioned somewhere between brackets 320 and 322, it will be understood that movement of handle grips 328 and 340 toward or away from each other will cause rotation of handle elements 300 and 302 about a pivot axis through pin 304 with consequent movement of brackets 320 and 322 secured to each of the handle elements whereby blades 332 and 334 will move in an arcuate path toward or away from each other.

Preferably, resilient biasing means of any suitable type is secured between handle grips 328 and 330 in such manner'as to bias the grips away from each other toward the limit of their movement, which desirably will occur when the distal ends of blades 332 and 334 contact each other. Illustratively, a single coil spring as suggested by spring 336 may be used for the foregoing purpose as shown in FIGS. 27 and 28. To prevent escape of spring 336 when no blades are mounted in the instrument shown in FIG. 27, for example, a limit stop such as a lug 338 integrally formed on lobe 310 may be used to make interfering contact with a projecting boss 340 integrally formed on lobe 308 of handle 300 to prevent any further relative rotation between handles 300 and 302 under the force of spring 336 after the stated lug and boss contact each other. In addition to the structure described above, it may seen from FIG. 30 that means are included in the device shown by FIG. 27 for easily ejecting blades 332 and 334 from their supported position within cavities 324 and 326 in brackets 320 and 322, respectively. As seen from FIG. 30, the stated ejection means include a rotatable lever 344 which is adapted to make bearing contact with the end of blade element when it is inserted within cavities 324 and 326, this action resulting in rotation of the stated lever in a direction resulting in a portion of the lever projecting outwardly from each of the brackets 320 and 322. Upon completion of use, manual force applied to the mentioned levers will apply force to each of the blades in a direction which will result in ejection of each blade from its cavity.

1 claim:

1. A combined vaginal speculum and tenaculum comprising:

a handle;

a first speculum blade connected to the handle;

a second speculum blade opposed to the first blade;

means for connecting the second blade to the handle for relative movement of the first and second blades towards and away from each other;

means on the distal end of each of the blades for securely engaging the exterior peripheral rim of a cervix; and 7 means for resiliently biasing the blades towards each other.

2. A combined vaginal speculum and tenaculum as defined in claim 1 wherein the means for engaging the cervix comprises a plurality of spaced apart projections on each blade, said projections on one of the blades extending generally towards the projections on the opposed blade.

3. A combined vaginal speculum and tenaculum as defined in claim 1 wherein the means for engaging a cervix comprises cups of flexible resilient material having a thin, easily deformed, peripheral edge.

4. A combined vaginal speculum and tenaculum as defined in claim 3 further comprising means for connecting a vacuum to the interior of the cups.

5. A combined vaginal speculum and tenaculum as defined in claim 1 further comprising means for illuminating a proximal end portion of at least one of the blades and wherein said illuminatedblade is transparent and has a sufficiently regular exterior for transmitting light from the proximal end portion substantially to the distal end.

6. A combined vaginal speculum and tenaculum as defined in claim 1 wherein the means for connecting each of' the blades to the handle comprises means for temporarily connecting the blade to the handle.

7. A combined vaginal speculum and tenaculum as defined in claim 6 wherein each of the blades includes a frangible portion for disconnecting the respective blade from the handle.

8. A combined vaginal speculum and tenaculum as defined in claim 6 wherein the means for connecting the second blade to the handle for relative movement comprises:

means for translating a proximal end portion of the second blade relative to the first blade; and means for tilting one of the blades about its proximal end relative to the other blade.

9. A combined vaginal speculum and tenaculum as defined in claim 6 whereinthe means for connecting each of the blades to the handle comprises a slot in the handle; and wherein the blade includes a curved portion fittable into the slot, the relative size of the curved portion of the blade and the slot providing an interference fit whereby the blade is slightly deformed in the slot.

10. A vaginal speculum comprising: a handle;

a first speculum blade; means for temporarily connecting the first speculum blade to the handle; a second speculum blade; means for temporarily connecting the second speculum blade to the handle and opposed to the first speculum blade; and means on the handle for moving the blades towards and away from each other; and wherein each of the speculum blades includes a frangible portion for disconnecting the blades from the handle. 11. A vaginal speculum as defined in claim 10 wherein the frangible portion comprises a region of reduced transverse cross section on the blade for a manual breakage thereof. 1

12. A vaginal speculum as defined in claim 10 wherein the means for temporarily connecting each speculum blade to the handle comprises:

a slot in the handle elongated in a direction transverse to the length of the blade; and

a transversely curved portion on the blade fittable into the slot, the relative size of the blade and slot requiring increased curvature of the blade to fit into the slot for providing an interference fit therebetween.

13. A vaginal speculum as defined in claim. 12 wherein each blade further comprises a projecting bead for engaging a portion 'of the handle for positioning the blade in a predetermined position.

14. In a vaginal speculum comprising a pair of opposed speculum blades connected at their proximal ends to an operating handle, said handle including means for translating the proximal ends of the blades towards and away from each other and means for tilting the blades relative to each otherabout their proximal ends, the improvement comprising:

means on the distal end of each of the blades for securely engaging the exterior peripheral rim of a.

the further improvement wherein each of the blades includes a frangible portion for selectively removing the blade from the handle.

t I! t It 

1. A combined vaginal speculum and tenaculum comprising: a handle; a first speculum blade connected to the handle; a second speculum blade opposed to the first blade; means for connecting the second blade to the handle for relative movement of the first and second blaDes towards and away from each other; means on the distal end of each of the blades for securely engaging the exterior peripheral rim of a cervix; and means for resiliently biasing the blades towards each other.
 2. A combined vaginal speculum and tenaculum as defined in claim 1 wherein the means for engaging the cervix comprises a plurality of spaced apart projections on each blade, said projections on one of the blades extending generally towards the projections on the opposed blade.
 3. A combined vaginal speculum and tenaculum as defined in claim 1 wherein the means for engaging a cervix comprises cups of flexible resilient material having a thin, easily deformed, peripheral edge.
 4. A combined vaginal speculum and tenaculum as defined in claim 3 further comprising means for connecting a vacuum to the interior of the cups.
 5. A combined vaginal speculum and tenaculum as defined in claim 1 further comprising means for illuminating a proximal end portion of at least one of the blades and wherein said illuminated blade is transparent and has a sufficiently regular exterior for transmitting light from the proximal end portion substantially to the distal end.
 6. A combined vaginal speculum and tenaculum as defined in claim 1 wherein the means for connecting each of the blades to the handle comprises means for temporarily connecting the blade to the handle.
 7. A combined vaginal speculum and tenaculum as defined in claim 6 wherein each of the blades includes a frangible portion for disconnecting the respective blade from the handle.
 8. A combined vaginal speculum and tenaculum as defined in claim 6 wherein the means for connecting the second blade to the handle for relative movement comprises: means for translating a proximal end portion of the second blade relative to the first blade; and means for tilting one of the blades about its proximal end relative to the other blade.
 9. A combined vaginal speculum and tenaculum as defined in claim 6 wherein the means for connecting each of the blades to the handle comprises a slot in the handle; and wherein the blade includes a curved portion fittable into the slot, the relative size of the curved portion of the blade and the slot providing an interference fit whereby the blade is slightly deformed in the slot.
 10. A vaginal speculum comprising: a handle; a first speculum blade; means for temporarily connecting the first speculum blade to the handle; a second speculum blade; means for temporarily connecting the second speculum blade to the handle and opposed to the first speculum blade; and means on the handle for moving the blades towards and away from each other; and wherein each of the speculum blades includes a frangible portion for disconnecting the blades from the handle.
 11. A vaginal speculum as defined in claim 10 wherein the frangible portion comprises a region of reduced transverse cross section on the blade for a manual breakage thereof.
 12. A vaginal speculum as defined in claim 10 wherein the means for temporarily connecting each speculum blade to the handle comprises: a slot in the handle elongated in a direction transverse to the length of the blade; and a transversely curved portion on the blade fittable into the slot, the relative size of the blade and slot requiring increased curvature of the blade to fit into the slot for providing an interference fit therebetween.
 13. A vaginal speculum as defined in claim 12 wherein each blade further comprises a projecting bead for engaging a portion of the handle for positioning the blade in a predetermined position.
 14. In a vaginal speculum comprising a pair of opposed speculum blades connected at their proximal ends to an operating handle, said handle including means for translating the proximal ends of the blades towards and away from each other and means for tilting the blades relative to each other about their proximal ends, the improvement comprising: means oN the distal end of each of the blades for securely engaging the exterior peripheral rim of a cervix; and means for resiliently biasing the blades toward each other.
 15. In an improved speculum as defined in claim 14 the further improvement wherein the means for engaging a cervix comprises a plurality of teeth on the distal end of each of the blades for engaging the cervix with sufficient force to stabilize it.
 16. In an improved speculum as defined in claim 15 the further improvement wherein each of the blades includes a frangible portion for selectively removing the blade from the handle. 